Importance of blood pressure control in hemodialysis patient survival

Mazzuchi, Nelson; Carbonell, Enriqueta; Fernández‐Cean, Juan

doi:10.1111/j.1523-1755.2000.00388.x

Cited by 152 publications

(104 citation statements)

References 26 publications

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“…The changing relationship of BP with mortality over time observed in this study is in concert with a report by Mazzuchi et al (18). These investigators observed that low BP was associated with increased mortality during the early years of dialysis, whereas high BP was associated with mortality in later years.…”

Section: Discussionsupporting

confidence: 78%

Changing Relationship of Blood Pressure with Mortality over Time among Hemodialysis Patients

Stidley

Hunt

Tentori

et al. 2006

Journal of the American Society of Nephrology

128

106

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High BP is a major risk factor for atherosclerotic cardiovascular disease mortality in the general population. Surprising, studies that have been conducted among hemodialysis (HD) patients have yielded conflicting data on the relationship between BP and mortality. This study explores two hypotheses among HD patients: (1) The relationship between BP and mortality changes over time, and (2) mild to moderate hypertension is well tolerated. Incident HD patients who were treated at Dialysis Clinic Inc. facilities between 1993 and 2003 were studied. Primary end points were atherosclerotic cardiovascular disease and all-cause mortality. The relationship between BP and mortality was analyzed in two sets of Cox proportional hazards models. Model-B explored the relationship between baseline BP and mortality in sequential time periods. Model-TV assessed the relationship between BP, treated as time-varying, and mortality. The study sample (n ‫؍‬ 16,959) was similar in characteristics to the United States Renal Data Systems population, although black patients were slightly overrepresented. Model-B demonstrated that the relationship between baseline BP and mortality changes over time. Low systolic BP (<120 mmHg) was associated with increased mortality in years 1 and 2. High systolic BP (>150 mmHg) was associated with increased mortality among patients who survived >3 yr. Low pulse pressure was associated with increased mortality. Model-TV demonstrated that mild to moderate systolic hypertension may be relatively well tolerated. In conclusion, the relationship between baseline BP and mortality changes over time. Mild to moderate systolic hypertension was associated with only modest increases in mortality.

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Section: Discussionsupporting

confidence: 78%

Changing Relationship of Blood Pressure with Mortality over Time among Hemodialysis Patients

Stidley

Hunt

Tentori

et al. 2006

Journal of the American Society of Nephrology

128

106

View full text Add to dashboard Cite

show abstract

“…[158][159][160][161][162][163][164] As previously discussed, controversy relates to the specific relationship between the BP measurement times and technique (predialytic, postdialytic, or intradialytic BP measurements or interdialytic ambulatory BP) and morbidity and mortality. Some studies suggest an association of high BP with strokes, 165,166 cerebral atrophy, 167 cardiovascular events, 168 complex cardiac arrhythmias, 169 the development of congestive heart failure, 161 and all-cause mortality.…”

Section: Relationship Of Bp and Mortalitymentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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“…Although an increase in the blood pressure is both a cause and a consequence of chronic kidney disease. It predisposines these patients to risk of development of left ventricular hypertrophy, congestive heart failure, stroke and other cardiovascular and neurological complications leading to high morbidity and mortality in these patients [16][17][18][19]. In the present study although all hypertensive patients were receiving antihypertensive medications yet their blood pressure were not adequately controlled which may be due to the failure to maintain optimal dry weight [20].…”

Section: Anti-hypertensive Medication and Blood Pressure Control In Hmentioning

confidence: 45%

Efficacy of Various Antihypertensive Drugs in the Treatment of Hypertension in the Patients of End-Stage Renal Disease Leading to Haemodialysis- A Retrospective Study

Ahmad¹,

Rehman²,

Habib³

et al. 2017

J Nephrol Ther

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Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in the patients of end-stage renal disease leading to hemodialysis. Majority of these patients suffers from hypertension and adequate control of blood pressure is a challenge in these patients because of multifactorial etiology and complicated pharmacokinetic changes in these patients. The present study aims is to find out the best possible drug or combination of drugs that can provide better control of blood pressure and improve the quality of life of these patients.

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Importance of blood pressure control in hemodialysis patient survival

Cited by 152 publications

References 26 publications

Changing Relationship of Blood Pressure with Mortality over Time among Hemodialysis Patients

Changing Relationship of Blood Pressure with Mortality over Time among Hemodialysis Patients

Assessment and Management of Hypertension in Patients on Dialysis

Efficacy of Various Antihypertensive Drugs in the Treatment of Hypertension in the Patients of End-Stage Renal Disease Leading to Haemodialysis- A Retrospective Study

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